Osteoporosis: Expanded Criteria Protects More Patients

There is new work examining the impact the National Bone Health Alliance’s (NBHA) expanded criteria for diagnosing osteoporosis would have on the prevalence of the condition in the U.S.

Ethel Siris, M.D. is the paper’s senior author and chair of the NBHA Clinical Diagnosis Working Group, NBHA Executive Committee member, Madeline C. Stabile Professor of Medicine and Director of the Toni Stabile Osteoporosis Center at Columbia University Medical Center, New York-Presbyterian Hospital. Dr. Siris told OTW, “The new publication [“The impact of the new National Bone Health Alliance (NBHA) diagnostic criteria on the prevalence of osteoporosis in the USA”] was the result of an earlier paper by the NBHA Clinical Diagnosis of Osteoporosis Working Group that called for the expansion of the criteria for making a diagnosis of osteoporosis in men and post-menopausal women over age 50 in the United States. The expansion of the diagnostic criteria was intended to ensure that patients with low bone mass (who do not have a T-score at the spine or hip less than or equal to -2.5) but who were still at high risk for fracture based on having low bone mass and certain qualifying fragility fractures or had high fracture risk based on the Fracture Risk Assessment Tool (FRAX), were not missed as having osteoporosis by their physician. The working group consisted of clinician and clinical scientists, including an orthopedic surgeon, that worked for over a year to achieve consensus on the new criteria. Both the American Academy of Orthopaedic Surgeons and the International Geriatric Fracture Society have endorsed this expansion of the criteria for diagnosis.”

“The new publication emerged from the obvious next question, which was to determine the prevalence of osteoporosis when the diagnosis is expanded beyond solely a T-score diagnosis. We were able to determine that overall 16% of men and nearly 30% of U.S. women age 50 and older would be classified as having osteoporosis, an increase from the previous estimate of osteoporosis in people age 50 and older (based solely on T-score measurements of -2.5 or lower at the spine or hip) that would have classified 4.3% of men and 15.4% of women as having osteoporosis. Among people age 80+, we found that 46% of men and 77% of women have osteoporosis with the new criteria.”

“For the orthopedic surgeon one clear message is that when someone over 50 presents with a low energy fracture, a subsequent evaluation for osteoporosis is critical, consisting of a bone density test in virtually all cases (though after a hip fracture our new criteria say that is adequate to make an osteoporosis diagnosis; for other fractures, the bone density test is still needed), and a laboratory work up to rule out vitamin D deficiency and other secondary factors that might have contributed to osteoporosis. Medical management is warranted if the diagnosis is made, including adequate calcium and vitamin D and osteoporosis medications. Fall risk reduction is also critical. One proven way to assure that such fracture patients are managed to prevent the next fracture is through fracture liaison services, where either the orthopedic surgeon’s own staff or a formal link to a medical specialist who treats osteoporosis navigates the post-fracture patient into medical management.”